Ma zui xue za zhi = Anaesthesiologica Sinica最新文献

This study was conducted in 30 adult patients with ASA class I-II physical status who received minor operations. Anesthetic induction was achieved by injecting thiopental 4 mg/kg intravenously in addition to N2O/O2 (4L/2L) delivered via Ventri Mask, followed by alfentanil 7 micrograms/kg intravenously 3 min later. Maintenance of anesthesia was accomplished by N2O/O2 in conjunction with alfentanil 0.25-2.5 micrograms/kg/min, delivered intravenously by a syringe pump. Our result showed that in an operation of average duration around 40.2 +/- 10.5 min., the average dose of alfentanil used was 0.62 +/- 0.15 micrograms/kg/min. The respiration rate fell from 13.4 +/- 0.4 cpm to 8.4 +/- 1.1 cpm 2 min later following alfentanil injection, which was statistically significant. SaO2 fell from 97.9 +/- 0.4% to 94.0 +/- 0.8% 3 min after alfentanil injection, which was statistically significant. End-tidal carbon dioxide partial pressure elevated from 39.4 +/- 0.6 mmHg to a peak of 45.3 +/- 1.2 mmHg 5 min after alfentanil injection which was also statistically significant. Temporary apnea was noted in 3 cases, but they all resumed spontaneous respiration after a short period of assisted ventilation. Changes in systolic and diastolic pressure during anesthesia were not marked. Pulse rate was noted to decrease from 80.3 +/- 2.7 bpm to 70.5 +/- 2.0 bpm 1 min after alfentanil injection, which was statistically significant (p less than 0.05). After discontinuation of N2O, the time required to regain the ability to follow orders of "open your eyes," "show your thumb" and "say your name" in sequence was 72.5 +/- 10.6s, 88.2 +/- 11.6s, 128.1 +/- 23.0s, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Interpleural analgesia for postoperative pain with bupivacaine 0.25%, 0.375% and 0.5% at dosage of 1.5 mg/kg was evaluated in three randomized groups (A, B and C) of 22 children having triple ligation for patent ductus arteriosus (PDA). Complete pain relief was obtained within 30 min irrespective of the concentration of bupivacaine. The duration of pain relief significantly varied with the concentrations of the drug used, respectively 5.02 +/- 0.4 h, 6.88 +/- 0.7 h and 8.24 +/- 1.08 h (mean +/- SD) for 0.25%, 0.375% and 0.5% bupivacaine (p less than 0.05). No side effects were observed and no other supplemented narcotics were given. We concluded that 0.5% bupivacaine at the dose of 1.5 mg/kg was effective in postoperative pain relief after thoracotomy in patients undergoing PDA ligation surgery.

From March 1, 1990 to August 31, 1991, there were four hundred and forty eight female patients undergoing major lower abdominal obstetric and gynecologic operations in our hospital. The most frequently performed operation in our series was Cesarean section (80.8%). Besides, there were operations for ectopic pregnancy, ovarian cyst, fallopian tube problems and abdominal total hysterectomy as well as radical hysterectomy for cervical cancer. Most of the operations were done under spinal anesthesia (91.3%). The rest were performed under epidural anesthesia (2.2%), general anesthesia (4.9%) or a combined anesthetic technique (1.3%). On one occasion, a Cesarean section was done during cardio-pulmonary resuscitation in the emergency room. Another parturient developed cardiac arrest during spinal anesthesia for Cesarean section with successful resuscitation. Otherwise, only minor complications such as post dural puncture headache (6.4%), nausea and vomiting (13.51%) and hypotension (38.2%) were found. All complications responded to conservative therapy that no prolonged hospitalization or unacceptable Apgar score in the newborns was noted. In addition, intra-operative blood transfusion was a rare occurrence. Thus, spinal anesthesia is a safe, effective, simple and inexpensive anesthetic method for major obstetric and gynecologic operations particularly in a rural hospital.

Glycerine has long been used with phenol as a drug depot in control of intractable pain. However, through our literature review, glycerine has never been used to prolong the pharmacological effects of a local anesthetic, such as bupivacaine. Our study is an attempt to use the same mechanism to further extend the pharmacologic effects of a popular long lasting anesthetic in a commonly used technique. Fifteen adult patients with cancer pain received 0.125% bupivacaine via a chronically implanted epidural catheter. In a blind study of pain control: Group I, consisting of 8 patients, received 5 ml 0.125% bupivacaine in normal saline; group II, consisting of 7 patients, received the same amount of the same strength anesthetic dissolved in 50% glycerine. The pharmacological effect was assessed by evaluation of intensity and duration of sensory as well as motor blockade. Our preliminary experimental experience revealed that significant prolongation (11.8 +/- 2.3 h vs 7.6 +/- 1.8 h, p less than 0.01) of analgesia was observed with the glycerine solution as compared to the saline solution. There was no motor blockade or other adverse effects or complications. This markedly prolonged analgesic effect is attributed to the slow release of the local anesthetic agent from the glycerine base which functions as a drug depot. Other clinical applications of this novel approach in pain relief are currently under investigation.

The desire to improve anesthetic outcome is a cornerstone in modern anesthesia. There are many means to reach this goal, such as enforcement in personal training, elevation of monitoring standards, constant vigilance and stern quality assurance (QA). The department of Anesthesiology, Tri-Service General Hospital, has adopted the QA program and implemented it since March 1, 1990. Because there were no significant differences in terms of personnel training, monitoring standards and types of anesthesia and surgery before and after the application of QA program, we investigated the effects of QA on anesthetic major morbidity and coma/mortality. We analyzed the anesthetic results obtained in two separate periods respectively spanning from Jan. 1, 1989 to Dec. 31, 1989 and from Mar. 1, 1990 to Feb. 28, 1991. During the first two months of 1990, the department's personnel were trained to be familiar with the QA program. We compared the anesthetic major morbidity and coma/mortality of one year before the implementation of QA with those in a one-year period after its implementation. Before and after enforcement of QA, there were no significant differences (p greater than 0.05) regarding major morbidity and coma/mortality, but the rates of anesthetic complications were lower after the practice of QA program. Since the functions of QA was aimed at alerting the anesthetic personnel to keep constant vigilance over the act of anesthesia, QA in theory could reduce anesthetic accidents and mishaps related jointly to surgery and anesthesia. The reason why QA did not decrease anesthetic major morbidity and coma/mortality in this study may be due to limited number of anesthesia in relatively short period.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate adequate anesthetic depth without unacceptable respiratory consequences during total propofol intravascular anesthesia without intubation, the respiratory response was studied in 20 healthy patients (ASA class I or II), aged 20-50, premedicated with fentanyl 2 micrograms/kg. Anesthesia was induced in all patients with propofol 2.5 mg/kg, subsequently maintained by continuous propofol infusion at 12 mg/kg/h. An additional bolus of 20-60 mg propofol was given when anesthesia was considered inadequately. Assisted ventilation with 100% oxygen through a face mask was applied when apnea time was longer than 60 s. The mask was removed when patients regained spontaneous breathing. During induction stage, 7 patients developed apnea which required ventilatory support, although the period of apnea was short. Among them four regained spontaneous breathing within 5 min, and three within 10 min. PaCO2 significantly increased at both 10 min and 20 min after induction as compared with those before induction (p less than 0.05), while the change between 10 min and 20 min after induction was not statistically different. PaO2 showed little change and also it was not statistically significant. During maintenance of anesthesia spontaneous ventilation was stable and adequate. Though mild hypercapnia was noted, no medication was necessary. There was no episode of arterial oxygen desaturation throughout the course of maintenance. All patients could be adequately anesthetized except for six patients who required additional dose for insufficient anesthetic depth. No major adverse reactions occurred during or after induction. We concluded that the respiratory effect of propofol in total intravenous anesthesia could be divided into two stages: the induction stage and the maintenance stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Spinal anesthesia (SA) is frequently used in parturients undergoing Cesarean sections (C/S). The body height (BH) is commonly believed to be one of the factors influencing the spread of SA, especially in patients with extremes of the BH. Recent studies, however, show that the spread of SA is not related to the BH but to the vertebral column length (VL). This study aims to evaluate the relationship between the BH and VL in Chinese parturients. 258 parturients without vertebral column abnormality undergoing C/S were included in this study. The VL (between C7 prominence and sacral hiatus) of each patient was measured in the right decubitus position. They were divided into 3 groups according to their BH (group A less than 152 cm; group B = in the range of 153-161 cm; group C greater than 162 cm). In each group correlation between the BH and VL was made by linear regression analysis. Also determined is whether there is significant difference between each two groups by unpaired Student's t-test. A p values less than 0.05 is considered as statistical significance. The results of the present study showed that although there exists correlation between the BH and VL, the correlation coefficient (r value) is small in each group (0.29, 0.13, and 0.31 in Group A, B, and C respectively; p less than 0.05). There is, also, no significant difference of the VL among the three groups. Therefore we concluded that the BH and VL did not closely correlate and therefore BH might contribute little to the spread of SA in the Chinese parturients, including those with extremes of BH.